ORAL MEDICATIONS Flashcards
medication
substance used in diagnosis, treatment cure, relief of prevent health alteration
medication may be prescription, non-prescription, complementary/herbal preparation
acute care - RN roles
ensure pt. prepared to administer meds when discharged
educate pt. about meds & side effects
ensure med regimes are ‘fit for purpose’, practice & sustainable
assesses effects of meds in restoring/maintaining health
Aus national med policy
maximise indiv. benefit from med regime
achieve safe, effective & appropriate use of meds & optimise medicinal use
quality use of medicines
aus response -> National Medicines Policy
wise -> ensuring best treatment plan
necessary -> ensuring when meds are needed, theyre carefully selected, managed, monitored & reviewed
safe & effective -> minimising misuse, overuse & underuse while achieving goals of therapy by delivering beneficial changes in health outcomes
medication team
prescriber
nurse
pharmacists
medication management cycle
working together in all aspects to prevent an error
prescriber -> prescribe/issue med
pharmacist -> review medicine order, issue of med, education patient
nurse -> distribute/storage of med, adminster/monitor med response, transfer of verified info, educate patient
RNs role in meds
RN’s prescribing/administering meds are accountable for knowing meds prescribed, therapeutic/non-therapeutic effects & patients need for med
provides education to patient & family about med & effects
assesess patients need for med before dose
evaluates therapeutic & non-therapeutic effects of medication & clinical outcomes
errors in medication cycle
ordering, transcribing, dispensing, administering
O-> wrong dose, drug, route/form, allergy/drug interaction
T -> dose, route, patient, time, drug
D -> dose, route, patient, time, incorrect labelling/drug ID, primary catch for allergy/drug interaction
A -> patient, dose, drug, time/omitted, route, frequently involves infusion pump
pharmacokinetics
study how medication enters body, moves through body & leaves body
pharmacodynamics
process in which med interacts with body cells to produce biological response
therapeutic effect
desired result or action of med
absorption
passage of a drug from administration site to bloodstream
distribution
process of delivering mediation to tissues, organs & the specific site of action
metabolism
process by which drug is altered to less active form to prepare for excretion
excretion
process removes less active drug or its metabolites
adverse drug reaction
harmful unintended reaction to medicines that occur at doses normally used for treatment
medication interactions
when drug action is modified by presence of certain food/herb or other medication
antagonism
occurs when drug effect is decreased by taking the drug with another substance
drug incompatibility
mixing medications in solution that causes precipitation or combining drug with another that causes adverse chemical reaction
diversity considerations
pregnancy -> extreme risk to developing foetus
infants -> require smaller doses
older adults -> increased side effects
gender -> drug actions differ based on hormone levels & distribution of body fat
genetics -> affecting drug metabolism & influence dosage needs
cultural factors -> herbal med may affect action of prescribed meds
pharmacodynamics
drugs half life -> expected time it takes for blood conc. to measure half of original drug dose due to drug elimination
onset of action -> time body takes to respond to drug after administration
plasma plasma level -> indicated highest serum (blood) concentration
trough -> lowest serum level of medication
side effects
predictable but unwanted & sometimes unavoidable reactions to medications
toxic effects
result from medication overdose or the buildup of medication in the blood due to impaired metabolism & excretion
allergic reactions
unpredictable immune responses to medications
routes of administration
Oral Routes -> oral, sublingual, buccal
Parenteral Routes -> subcutaneous, intradermal, intravenous, intramuscular, epidural, intrathecal, intraosseus, intraperitoneal, intradermal, intraarterial
Topical Routes -> skin, mucous membranes, inhalation, introcular
dosage calcs
Tablets -> dose required = amount to be administered stock strength
Liquids -> dose required x volume = amount administered stock strength
benefits of EMMS
fewer prescribing errors
lower dispensing errors through med orders, automation & barcode scanning
reduced admin errors through clearer info
less omission/commission errors in care through improved info transfer
improved med adherence & minimised misuse, overuse & underuse of meds
medication errors
any event that could cause/lead to incorrect administration to prescribers orders
may occur when RN fails to follow routine procedures
preventable errors
use of incorrect drug
prescribing errors
administration errors
incorrect drug
legal/valid orders
written/printed in ink / entered in EMMS
signed by prescriber & contact number
full name of recipient, medication, dosage, route, frequency
reason for administration
detail the number of times drug may be dispensed or time between repeated administrations
reason for med
RN must assess if reason for med is valid
medicine needs to be assessed as being appropriate for patient in current state
RN must assess patient for particular med & evaluate if its been given for right reasons
if no reason is apparent, contact prescriber
5 rights of medication
right med / right reason right dose right patient right route right time / frequency
Drug Scheduling
Schedule 1-intentionally blank. Schedule 2- Pharmacy Medicine Schedule 3- Pharmacist Only Medicine prescription. Schedule 4- Prescription Only Medicine Schedule S4 appendixD: require storage and security (NSW) Schedule 5- Poisons of a hazardous nature Schedule 6-Poison Schedule 7 – Dangerous Poison Schedule 8- Controlled Drug substances which should be available for use but require restriction Schedule 9- Prohibited Substance
Prescribing rules
drugs in S4/8 must be prescribed by medical officer
in emergencies, verbal order is permitted by must be written up in 24hrs
NP’s can prescribe from predetermined formulae
accountable medications
S4D, S8
S4/SD4 drugs are liable to abuse
register of S8 drugs
record patients name prescribed drug/dose doctors name date/time of administration balance of ampoules/tablets/capsules or liquids in supply
RN’s accountability
responsible for own actions
required by law to be knowledgeable of meds
must be knowledgeable about restricted drugs
must sign chart after administration
document reason why med wasnt given
fatal errors
giving med prepared by someone else
signing med given by someone else
not checking correctly 5 rights 3 times
trade vs generic name
leaving medication by bedside & not watching them be consumed
administering med from unlabelled container
administering med where order is incorrect
caplet
solid dosage form for oral use, shaped like capsule & coated for ease of swallowing
capsule
solid dosage for oral use, medication in powder/liquid/oil form & encased in gelatine shell, capsule coloured to aid in product identification
elixir
clear fluid containing water and/or alcohol, designed for oral use, usually has sweetener added
enteric-coated tablet
oral use coated with materials that don’t dissolve in stomach, coatings dissolve in intestine, where medication is absorbed
extract
concentrated medication form made by removing active portion of medication from its other components e.g. fluid extract is medication made into solution from vegetable source
glycerite
solution of mediation combined with glycerine for external use, contains at least 50% glycerine
intra-ocular disc
small flexible oval consisting of 2 soft outer layers & a middle layer containing medication, when moistened by ocular fluid, releases medication for up to a week
liniment
preparation usually containing alcohol, oil or soapy emollient that is apples to skin
lotion
medication in liquid suspension applied external `
ointment
semi-solid, external applied preparation, usually containing one or more medications
paste
semi-solid prep, thicker & stiffer than ointment, absorbed through skin more slowly than ointment
pessery
solid dosage form mixed with gelatine & shaped into form of pellet for insertion into vagina, melts when it reaches body temp, releasing medication for absorption
pill
solid dosage form containing one or more medications, in globule, avoid or oblong shape, true pills are rarely used because they have been replaced by tablets
solution
liquid prep that may used orally, parenterally or externally, can also be instilled into body organ or cavity e.g. bladder irrigations, contains water with one or more dissolved compounds, must be sterile for parenteral use
suppository
solid dosage form mixed commonly with gelatine or wax & shaped into form of pellet for insertion into rectum, melts when reaches body temp, releasing medication for absorption
suspension
finely divided drug particles dispersed in liquid medium, when suspension is left standing, particles settle to bottom of container, commonly an oral medication & not given intravenously
syrup
medication dissolved in conc. sugar, may contain flavouring to make medication more palatable
tablet
powered dosage form compressed into hard disks or cylinders
tincture
alcohol or water - alcohol medication solution
transdermal disc/patch
medication contained within semi-permeable membrane disc or patch which allows medications to be absorbed trough skin slowly over long period
troche / lozenge
flat, round dosage form containing medication, flavouring, sugar & mucilage, dissolves in mouth to release medication
in the morning
mane
night
nocte
twice a day
bd
three times a day
tds
four times a day
qid
when required
prn
immediately
stat
extended/sustained release coated drug
extends release over time reduces number of doses
sublingual
place medication under tongue until tablet dissolves. Blood telesales under tongue are very close to surface
buccual
place between cheek & teeth until dissolved
3 checks (5 rights)
1st -> prior to disposing med
2nd -> after dispensing med
3rd -> immediately prior to administering med to pt.
right medication check
check selected med against order (check MIMS)
check 3 times -> when selecting, when removing, when returning
right patient
check pt. ID band
ask their name & DOB
check name & patient ID against med chart
common abbreviations
subcut -> subcutaneous IM -> intramuscular IV -> intravenous PICC -> peripherally inserted central catheter PEG -> percutaneous enteral gastronomy PO -> oral subling -> sublingual PR -> per rectum PV -> per vagina NEB -> nebuliser MA -> metered aerosol NG -> nasogastric
reasons for nurse not administering
must be recorded
if pt. refuses, prescriber must be notified
if med withheld, reason must be documented in medical notes
if med not available, person administering has to notify pharmacy, obtain supply or contact prescriber
its appropriate to withhold if theres known adverse drug reaction
withhold if pt is pre-operative, NBM or fasting
telephone medication order
person receiving order must be authorised
due to misinterpretation, orders must be read back to prescriber with numbers, figures & words
prescriber should repeat to second person
administration must be recorded on med chart in telephone order section
loss of S4 / S8 drug
report to nurse in charge
complete incident report
immediately record balance in drug register with witness highlighting deficit
note to hospital director & director of pharmacy/nursing
director of pharmacy notify NSW ministry of health
eye drop method
clean patients eyes
prevent accidental contact of eye dropper with eye structure
when administering medications that cause systemic effects
apply gentle pressure with finger & clean tissue on clients nasolacrimal duct for 30-60 seconds
apply thin stream of ointment evenly along inner edge of lower eyelid on conjunctive from the inner cants to the outer canthus
ear drops method
children (3 & under) -> pull auricle down & back
adult -> pull auricle upwards & outwards
